Thats is also what I see when I read abstracts. Failure of the BCG along with how long since a recurrence seems to be the theme on taking the next step. Which I hope none of us have to do but, will do if I have to. I have delevd into ASCO & Journal of Urology for a lot of ingo. Anyone can go in a s a guest or researcher.

Here is one other stat site: http://www.urotoday.com/37/browse_categories/bladder_cancer/bladder_preserving_strategies_for_muscleinvasive_bladder_cancer__abstract.html

See ASCO: http://gucancers.asco.org/CancerPortals/Genitourinary+Cancers/Page+Not+Found

See Journal: http://www.jurology.com/article/PIIS0022534705667936/fulltext

DX 5/6/2008 TAG3 papillary tumor .5 CM in size. 2 TURBS followed by 6 instillations of BCG weekly with a second round of 6 after a 6 week wait.

HI Ro.......just read this today in Uro today from Dr. Herr at MSK...don't know how many centers are using this Narrow Band Imaging technique but it does seem superior to white light.
http://www.urotoday.com/index.php?option=com_content&task=view_ua&id=2217311
To view this article just register...its free...your name and that your a consumer when they ask and then you always have free access to articles you might be interested in.
Pat

In the same link provided above, directly under Dr. Herr's report is a report from Dr. O'Donnell concerning the bladder sparing protocol of BCG + Interferon
as an option upon and after intial BCG "failure" for Superficial disease.

9
UI - 11547062
AU - O'Donnell MA; Krohn J; DeWolf WC
TI - Salvage intravesical therapy with interferon-alpha 2b plus low dose bacillus Calmette-Guerin is effective in patients with superficial bladder cancer in whom bacillus Calmette-Guerin alone previously failed.
SO - J Urol 2001 Oct;166(4):1300-4, discussion 1304-5
AD - Department of Urology, University of Iowa, Iowa City, USA.
PURPOSE: We determined whether combining low dose bacillus Calmette-Guerin (BCG) interferon-alpha 2B would be effective for patients in whom previous BCG failed. MATERIALS AND METHODS: A total of 40 patients in whom 1 (19) or more (21) previous induction courses of BCG failed received 6 to 8 weekly treatments of 1/3 dose (27 mg.) BCG plus 50 million units interferon-alpha 2B. Additional 3 week miniseries of further decreased BCG (1/10, 1/30 or 1/100) titrated to symptoms without changing the interferon-alpha 2B dose were given at 5, 11 and 17 months. In 12 patients a second induction course was given with 1/10 BCG plus 100 million units interferon-alpha 2B. There was multifocal disease in 39 patients, previous BCG had failed within 6 months in 34, disease was aggressive (stage T1, grade 3 or carcinoma in situ in 31, there had been 2 or more previous recurrences in 25 and disease history was greater than 4 years in 13. RESULTS: At a median followup of 30 months 63% and 53% of patients were disease-free at 12 and 24 months, respectively. Patients in whom 2 or more previous BCG courses had failed fared as well as those with 1 failure. Of the 18 failures 14 occurred at the initial cystoscopy evaluation. Of 22 patients initially counseled to undergo cystectomy 12 (55%) are disease-free with a functioning bladder. Combination therapy was well tolerated. CONCLUSIONS: While longer followup and larger multicenter studies are required to validate these encouraging findings, intravesical low dose BCG plus interferon-alpha 2B appears to be effective in many cases of high risk disease previously deemed BCG refractory. However, early failure while on this regimen should be aggressively pursued with more radical treatment options.

This is a continuation of a discussion that I am moving over from the "Maintenance BCG thread."

It began this way:

from Patricia

Having had Dr. Herr as my surgeon i can tell you he probably sees more blc than anyone and he's very no nonsense. His reasoning is along the lines of

"BCG may not be a panacea for stage T1 disease in the long term, particularly in the setting of rapid recurrence, more extensive penetration and/or carcinoma in situ. Progression at sanctuary sites, ultimate recurrence and progression with time, and issues affecting quality of life (bladder contraction from repeated resections and intravesical BCG) may affect the advisability of avoiding cystectomy. Despite the admonition that a patient's own bladder is better than a reconstructed one, the potential for cure and the qualifications of a reasonably well functioning orthotopic bladder may be preferable to many individuals who otherwise might die of unpredictably progressive disease."

I decided to do my own research on Dr. Herr's research and this is what I have found...I hope to look more into the statistics of other researchers when I have more time. The following does seem to QUALIFY that Dr. Herr's statement above is based on BCG "failure" in Superficial disease.

UI - 11547061
AU - Herr HW; Sogani PC
TI - Does early cystectomy improve the survival of patients with high risk superficial bladder tumors?
SO - J Urol 2001 Oct;166(4):1296-9
AD - Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
PURPOSE: We compared survival after early versus delayed cystectomy in patients with high risk superficial bladder tumors. MATERIALS AND METHODS: Of 307 patients with high risk superficial bladder tumors who were treated initially with transurethral resection and bacillus Calmette-Guerin (BCG) therapy 90 (29%) underwent cystectomy for recurrent tumor during a followup of 15 to 20 years. Disease specific survival distribution of these 90 patients was determined relative to the indications for and time of cystectomy. RESULTS: Of the 90 patients who underwent cystectomy 44 (49%) survived a median of 96 months. Of 35 patients with recurrent superficial bladder tumors 92% and 56% survived who underwent cystectomy less than 2 years after initial BCG therapy and after 2 years of followup, respectively. Of 55 patients with recurrent muscle invasive bladder disease 41% and 18% survived when cystectomy was performed within and after 2 years, respectively. Multivariate analysis showed that survival was improved in patients who underwent earlier rather than delayed cystectomy for nonmuscle invasive tumor relapse. CONCLUSIONS: Earlier cystectomy improves the long-term survival of patients with high risk superficial bladder tumors in whom BCG therapy fails.

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